8 Key Steps of the Medical Billing Process

medical billing cycle steps

Your firm will suffer if you make employees perform jobs that can be completed more quickly and easily by automated technologies. Employees who might otherwise be free to concentrate on more patient-centric, individualized service become frustrated, and their morale suffers as a result. Billers must also ensure that the bill complies with all applicable billing regulations. Typically, billers must adhere to rules set forth by the Office of the Inspector General (OIG) and the Health Insurance Portability and Accountability Act (HIPAA) (OIG). Due to space and efficiency concerns, we won’t go into great detail on OIG compliance criteria.

While you may feel your job is done, the medical billing revenue cycle is far from over. Input the proper coding for the services your patient received medical billing cycle steps at their visit. These codes translate the patient office experience into the language needed to file insurance claims for reimbursement.

Video: The Medical Billing Process

Invoices are sent to patients when required and payments are posted and reconciled. But much more happens before, after, and between in the medical biller’s workday. Following adjudication, https://www.bookstime.com/ the payer will send an explanation of benefits (EOB) to the patient. This EOB will provide a breakdown of how the patient’s coverage matched up to the charges attached to their care.

  • Billers must also ensure that the bill meets the standards of billing compliance.
  • If there are any discrepancies, the biller/provider will enter into an appeal process with the payer.
  • With healthcare continuing to have a high demand for qualified workers, many people are choosing medical billing and coding as a career.
  • Medical RCM software is essential for medical practices and facilities to streamline tasks.
  • Here’s where medical coding and medical billing meet — in the standardized codes that medical billers now use to create insurance claims and bills for patients.
  • It can take months and several communications before you reach the collection stage.

The claim will include patient information, procedure codes (CPT and HCPCS codes), a diagnosis code (an ICD code), and a demonstration of the medical necessity for the services provided. While claims may vary in format, they typically have the same basic information. Each claim contains the patient information (their demographic info and medical history) and the procedures performed (in CPT or HCPCS codes).

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But before we talk about shortening your billing cycle, it’s important to understand each of the steps involved. Adjusting to new reimbursement policies and coding regulations was not an easy task. Several practices reassessed their financial plans to boost revenue. Before implementing a billing app, you need to analyze your organization’s needs.

medical billing cycle steps

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